Cascade AIDS Project Awarded $100,000 For HIV Prevention Navigation

Cascade AIDS Project is proud to announce that it has been awarded $100,000 from Gilead Sciences, Inc. to fund HIV prevention navigation and STI testing work.

The program addresses the comprehensive set of projects and activities aimed at reducing cases of HIV and STI cases across the Portland, Oregon metropolitan region. Specifically, the program is comprised of easily accessible HIV/STI testing clinics, connection to treatment and support services for those testing positive, community education both for those testing positive to prevent further spread of infections and prevention education for the wider community, and one on one health education session for high-risk individuals focused on personalized prevention strategies.

“A key component of the HIV Prevention Navigation program is testing – which is a critical way to reduce new cases of HIV and limit spread of the epidemic. There is also a strong focus on helping individuals navigate the complicated systems and processes so they, and their partners, can remain in good health,” said Caitlin Wells, CAP’s Director of Healthcare Operations. “Our hope and expectation is that this program will allow us to keep up our work in the community connecting high-risk individuals to low-barrier testing programs and additional resources to guarantee a population that is thriving.”

The grant will fund CAP’s HIV prevention navigation work for one year. Download the full press release here: HIV Prevention Navigation.

CAP To Expand HIV Services In Washington State

CAP is pleased to announce that it has been selected by the Washington State Department of Health to provide HIV-related services for Clark and Skamania counties starting January 1, 2017.

Under this contract award, CAP will provide both case management and care support services for persons living with HIV and prevention services including access to HIV testing, condoms, and Pre-Exposure Prophylaxis for persons at high risk for HIV. These efforts and services align with the National HIV/AIDS Strategy and the End AIDS Washington Initiative’s primary goal to reduce new HIV infections in Washington State by 50% by 2020.

“We are thrilled to be selected by the Washington Department of Health to provide cohesive prevention and care services to Clark and Skamania counties,” said CAP’s Executive Director, Tyler TerMeer. “We understand that ending the HIV epidemic means addressing a full range of barriers to prevention and treatment. This contract allows us to expand our successful care support service model to Washington and builds upon our existing six-year track record of providing innovative and effect prevention services in the Vancouver area to allow us to serve more people.”

With respect to medical case management and care support services, CAP anticipates serving approximately 90% of persons living with HIV in these counties and will focus services on individuals with multiple barriers to medical engagement and medication adherence including people facing poverty, homelessness, housing instability, mental illness, and substance abuse. CAP’s expanded prevention services will go beyond HIV testing to ensure that there is an open dialogue with clients to assess risk and to link them to services and protocols which promote the best health outcomes for their particular

Dr. John Nusser joins CAP Board of Directors
Dr. John Nusser joins CAP Board of Directors

needs.

To better serve Washington state clients, CAP is pleased to welcome Dr. John Nusser, a Vancouver Washington-based family medicine doctor with a significant HIV practice to its Board of Directors. Dr. Nusser received his medical degree from University of Washington School of Medicine and is affiliated with PeaceHealth Southwest Medical Center.

CAP is eager to bring a version of its model of culturally affirming, trauma-informed and unified prevention and care services to SW Washington.

PrEP: A Physician’s Perspective

PrEP: A Physician’s Perspective

By: Matt Pizzuti, Contributor

It could be the most promising—and controversial—HIV prevention tool yet. When used correctly, pre-exposure prophylaxis (PrEP), the daily pill that blocks an HIV infection from taking root in the body, can ensure that HIV-negative people stay that way. Combined with other safer sex strategies such as condom use, PrEP transforms the HIV prevention landscape, but not without a dose of scrutiny as well. What, exactly, is the relationship between PrEP and other risk-reduction strategies like condoms? To understand how a medical doctor thinks about PrEP and discusses it with patients, we spoke to Dr. Christopher Evans, a physician and infectious disease specialist at Oregon Health and Sciences University who works with PrEP patients daily.

 

Matt Pizzuti: Can you tell me a little about what you do and your expertise in PrEP?

Christopher Evans, M.D.: I am an infectious disease trained physician, I trained in New York, and now I work at OHSU doing primary care and also infectious disease consultation. Within the clinic that’s HIV care. I also see patients that are at risk for HIV, partners of HIV-positive patients, etc, as well as the public at large.

 

MP: Who is PrEP recommended for?

CE: PrEP is recommended for anyone who is at risk for HIV; someone who has had possible previous STIs, which may mean you are at higher risk, and high-risk groups, such as someone with an HIV-positive partner, or someone with a partner or number of partners of unknown serostatus (in other words, someone who has sex with people without being able to verify that they are all HIV-negative).

MP: Many of the people currently receiving messages about PrEP are men who have sex with men, and I think it’s sometimes hard for individuals in that category to know whether they, individually, should be considering it. To make this a little simpler, who among at-risk populations would you NOT recommend PrEP for?

CE: First of all PrEP’s not recommended for anyone who’s not going to take it the way it’s prescribed. There also may be people in a long-term monogamous relationship who know the serostatus of their partners and know their partners don’t have HIV. There’s a gray area around monogamous serodiscordant couples (couples with one HIV-positive partner and one HIV-negative partner) when the HIV-positive partner has an undetectable viral load; we know the risk of transmission to the negative partner is low even with unprotected sex. I would add that the CDC still recommends PrEP for serodiscordant couples.In every relationship everyone has to make their own decisions, though. I’m not there to dictate, I’m there to give you the options and talk about your risk.
In more specific cases, PrEP may not be recommended for pregnant women, although we do know that in some cases some women are pregnant when they get HIV. There are some gray zones for people who have chronic hepatitis B because of the risk of a viral flare-up if you discontinue PrEP.

MP: Out in the community there are a lot of strong opinions about PrEP; it’s pretty common to hear people say that PrEP is being used as an “excuse” to have unprotected sex or that it’s leading to riskier behavior.

At the same time, people in public health roles are saying that PrEP is not a substitute for condoms, although it does make sex much safer if you’re not using condoms consistently. In your view, what’s the relationship between PrEP and condoms?

CE: So there are personal comments, and then there’s evidence. Even in big studies, there’s evidence that the incidence of risky behavior decreases in people on PrEP. The big one was iPrEx, a study on gay, bisexual and transgender women who have sex with men, one of the first that looked at using Truvada for PrEP and was used for FDA approval.

Subsequent studies looked at risky behaviors again and found that risky behaviors, over time, went down, in both those on PrEP and those receiving placebo. But both groups also got safe-sex messages while they are coming in, just as in a patient setting, where it’s not like it’s being just given to people without any counseling.

The analogy I use is, if you have a seat belt would you drive faster? Most people would say they would continue to drive the speed limit even with a seatbelt on because it’s the more prudent thing to do.

Regardless, I always talk to my patients about using condoms. Condom use has a lot of different steps, though, and it’s not just putting on the condom; it’s negotiating using the condom, it’s people going out and having a good time (drinking) and still having the wherewithal to use it, and condoms can break—so condoms as a strategy is not 100% effective because people are not 100% consistent. But I think condoms are a cornerstone of public health policy and still important. I’m not ready to throw them out the door and say you have this other option so we don’t need it anymore.

There’s also the issue that having one STD can increase your risk for others; getting syphilis will increase your risk for HIV. So I’ll talk about the way you can get syphilis or chlamydia or gonorrhea, which can be transmitted through oral sex, anal sex, etc, even while you’re on PrEP.

MP: A lot of us, when we go to get tested, have been counseled on the fact that unprotected oral sex is a safer sex option compared to unprotected anal sex, and that’s mainly because of the risk of HIV. Of course there’s still a risk for transmission of other sexually-transmitted infections. So If somebody is on PrEP, is there still a difference between unprotected anal sex and unprotected oral sex or are they about the same level of risk now?

CE: Anal sex is always going to the riskiest sex, especially if you are the receptive partner or the bottom. You could look at the scale of possible risks for HIV and I’d say that oral sex is at the very bottom, but I don’t think any public health official has said there is no risk for HIV from oral sex—it’s just at the very bottom risk.

 

MP: Right, but when it comes to other STIs—syphilis, gonorrhea, chlamydia—is there a difference between unprotected oral sex and unprotected anal sex? Most of the population that PrEP pertains to was already at risk for other STIs because, whether or not it’s ill-advised, very few people use condoms for oral sex.

And here’s why I mention that. One concern I see brought up again and again in the community is this idea that PrEP is driving a spike in sexually-transmitted infections because people are getting on PrEP and no longer using condoms. But one thing I’m not sure about is whether the increase in STIs is in the same population as PrEP users, and if unprotected anal sex would make all that much difference when most were already at risk for those infections through oral sex.
CE:
 I don’t know because there hasn’t been studies done. I don’t think anyone has explained the recent increase in STI rates and I don’t think anyone has linked it to PrEP. That would be a great study to be done, but at this point, nobody knows that to be the case.

 

For more information about PrEP or first steps if you are interested in getting on PrEP, email prep@cascadeaids.org. Find Dr. Christopher Evans’ info at OHSU here.

HIV and the African-American Community by Anthony Rivers, African American Peer Support Specialist

Anthony

If we are going to change the stigma of HIV, we have to stop living it. The African-American community has a history of avoiding or delaying healthcare for various reasons. Some of the concerns go back to the Tuskegee experiments in which hundreds of black men, for 40 years, were intentionally infected with Syphilis to allow the government to study the natural progression of the disease while untreated. Other habits are instilled in black youth inadvertently by our parents who only take us to the doctor in emergency situations. We are conditioned to wait and see due to fears and in many times our socioeconomic status. I fear the same mentality we developed to save us is now killing us.

When dealing with HIV, cancer, and other potentially lethal illnesses, early detection is imperative. Infection rates among the black communities are steadily on the rise because we are becoming infected and infecting others due to our barriers to the health care system. These barriers are part of a stigma in the community that dictates how we obtain health care and what information we share with our health care providers. Our doctors can’t help if we are not forthcoming with our real lives; however, we can’t be forthcoming with our real lives until we have the faith in our doctors that we can speak without judgment and/or shame.

As the greatest affected community, we have the power to begin to eradicate this disease, but it comes at a price. We must be willing to not only engage in preventative health care services but also show our younger generation how to properly access and use medical treatment. We must begin to evolve mentally and understand the dealings of the past are no longer ethically or legally tolerable. We need to educate ourselves on prevention as well as maintenance if we become infected with HIV. By getting tested, using protection, and educating ourselves and our neighbors, we can take a greater responsibility and begin to heal our communities one at a time. We no longer have to die of AIDS when we now have the tools to live productive lives with HIV.